Asian Journal of Research in Surgery

Diabetic foot lesions are complex complications of diabetes mellitus arising from peripheral neuropathy, peripheral arterial disease, infection, repetitive mechanical stress and impaired tissue repair. Standard care remains centred on debridement, pressure offloading, infection control, vascular assessment, glycaemic management, appropriate dressings and patient education, yet some ulcers remain difficult to heal. This review examines emerging and advanced therapies used beyond conventional wound care. The approaches considered include placenta-derived and amniotic products, collagen-based materials, smart hydrogels, negative pressure wound therapy, growth factors, platelet-rich plasma, tissue-engineered skin substitutes, oxygen-based therapies, photobiomodulation, nanotechnology, local drug-delivery systems and novel antimicrobial strategies. Advances in revascularisation, reconstructive surgery, digital monitoring, wearable technologies, telemedicine and artificial intelligence are also addressed. Particular attention is given to practical limitations, patient selection and integration of advanced therapies within multidisciplinary care. These interventions may support healing when used selectively as adjuncts to high-quality standard care, but their effectiveness depends on wound characteristics, infection control, vascular supply, offloading adherence and patient-specific biological and social factors. Current evidence is limited by heterogeneous protocols, variable product composition, small studies, inconsistent outcomes and insufficient long-term and cost-effectiveness data. Effective future management is therefore likely to require personalised, multidisciplinary pathways integrating vascular optimisation, regenerative approaches, digital surveillance and recurrence prevention, while maintaining established principles of comprehensive diabetic foot care.